Modern approach to the treatment of decompensated heart failure

The initial approach to the treatment of acute decompensated heart failure is based on the clinical presentation and, in some, various additional examinations. The classical clinical-hemodynamic approach intends to evaluate the volume and perfusion status, based on clinical parameters. This approach appears overly simplistic and needs to be revised in order to incorporate modern diagnostic and therapeutic tools that have been developed in the last few years. We propose a new treatment algorithm that includes all available options of assessing perfusion and volume status, including biochemical and imaging techniques, and gives recommendations on intravenous agents early in the course of treatment. All efforts should be made to prevent worsening of hypotension and renal dysfunction during the hospital course, since both are strong prognostic markers. New therapeutic options, such as natriuretic peptides, calcium sensitizers and others in development, provide benefits beyond the usual drugs and can be used in scenarios where traditional agents would not be considered.